| NPI | 1033858642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: TX 122134) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO 0007111) |
| 225X00000X Occupational Therapist (Licence: NV 2931) | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-01 |